March 18, 2025
Later today the members of the Assembly Health Committee will take up our OMIG Audit Reform bill that is co-sponsored by the Committee Chair, Assemblywoman Amy Paulin. It is our hope that the Committee will vote to move the bill forward (in this case directly to the Assembly Ways and Means Committee) for further consideration during the state budget making process.
We have been meeting quite regularly with representatives from both the Senate and the Assembly, to explain the elements of the new bill, to reinforce that the bill is a significant departure from prior legislation, and that we have made concessions based on the feedback we were hearing from some central staff who appear to be focused on any reduced savings (for the state) that might result from passage of a reform bill. We have pointed out time and again that the bill reflects audit best practices and actually emulates (in many instances) practices employed by the Medicare Program and other federal entitlement programs where regulators do not begin with extrapolation but instead use it as a last resort tool. Stand by for updates.
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Newer members of the NYS Council may not know that in 2021, after several years of advocacy designed to compel state regulators to enforce various laws, regulations and contract requirements relating to the carve in of behavioral health services to Medicaid managed care, the NYS Council issued numerous FOIA requests across 6 state agencies/regulators through our attorneys at Feldersman Leifer, seeking information regarding the general enforcement of these contract requirements and specifically, whether or not the state had enforced the Behavioral Health Expenditure Target (BHET) requirements (on the MCOs) that requires them to spend 96% of the per member per month funds they are paid (by the state) on actual services to Medicaid beneficiaries – and in this case, Medicaid beneficiaries receiving services through the OASAS and OMH systems of care. Through the FOIA process, we confirmed that the state had not enforced the BHET provision despite our services having been carved into Medicaid managed care since 2017. As a result some MCOs that had missed the required target had been sitting with these funds rather than utilizing them as required. Our concern stemmed from the fact that our systems of care were struggling mightily from the COVID-19 pandemic and rising overdose rates. The funds that were unspent by the MCOs that missed the target should have been returned to the state agencies for reinvestment. Ultimately we decided to engage legal counsel in the event that (even with our escalating advocacy) the state did not begin to enforce the contract requirement. Fortunately when we met with the Governor’s lead Counsel and explained that the OASAS and OMH systems of care were due the funds the MCOs had not earned, and as such our systems of care were deprived of these resources during an incredibly challenging time, the Administration looked into the matter and then moved quickly to rectify the problem by enforcing the provision for a period of 3 cycles (2018-2021).
According to the Report linked here: Managed Care Reports (Note: We also secured budget language to require this report be prepared and posted by DoH) , the state recouped approximately $220M for the periods between 2018-2021. These funds were returned to OASAS and OMH, and both Offices used the funds to ‘pay for’ rate increases across a broad range of OASAS and OMH programs and services. Beyond the $220M that was returned to Office, another $110M has been appropriated to OASAS and OMH (beyond the $220M) in each of the last 3 state budgets (the 2025-2026 executive budget is still being negotiated). Having said this we must continue to demand FULL transparency and hold everyone’s feet to the fire on this one. The NYS Council intends to FOIA the state on the remaining years that are not discussed in the Report recently posted here: Managed Care Reports
OMHs Joe Katagiri (replaced Emil Slane) recently posted something about all of this on his LinkedIn page in case you are interested. It took courage for Joe to do this. I encourage everyone to follow him on LinkedIn. He usually has useful information to share.
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Workforce Solutions Partnerships: Call to Action to Build a Sustainable Behavioral Health Workforce
March 17, 2025 – Health Management Associates (HMA)
The Workforce Solutions Partnership, a collaboration of The National Council for Mental Wellbeing, The College for Behavioral Health Leadership, and Health Management Associates has worked since 2021 to create both short and long-term solutions addressing the behavioral health workforce crisis. In this whitepaper, we issue a Call to Action to partners across all sectors to join us in this effort to drive pervasive change and ensure the future of behavioral health care. We need you to help us create and define the future of the workforce and envision a new system of care. This paper outlines the problem and highlights the efforts developed by our partnership, and mechanisms that can help to address the problem.
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Please see the attached documents:
1) HMA/National Council/CBHL Call to Action Workforce Solutions document